Physician Advisor, Utilization & Care Management

Ensemble Health Partners; United States; Remote; USD 198,000 - 297,000; Full time

Benefits offered by this job

Healthcare

Time off

Retirement

Well-being programs

Job summary

Ensemble Health Partners is seeking a Physician Advisor to lead resource and utilization management across hospital services, ensuring cost-effective care. Collaborate with medical leadership, staff, and residents to optimize care level, documentation, coding, and compliance.

Provide education, peer reviews, and periodic reporting to executive committees. The role emphasizes leadership decision making, coaching talent, and building a strong UM program with cross-functional teams across UR, Case

Qualifications

• MD/DO Physician (MUST have)

Responsibilities

• Status determinations for hospitalized patients.
• Perform peer to peers with payors’ medical directors.
• Short inpatient stay reviews.
• Review observation patients daily.
• Build relationship with medical staff and leadership to get their buy-in with UM issues.
• Attend UM Committees as subject matter expert.
• Assist with denials and appeals as appropriate.
• Educate medical staff on UM topics.
• Partner with UR nurses, IA staff, and Case Management to maintain and improve upon the UM process.
• Track denial trends to assist the team evolve to meet new payor challenges.

Education

MD/DO Physician

Job description

Ensemble Health Partners is seeking a Physician Advisor to lead resource and utilization management across hospital services, ensuring cost-effective care. Collaborate with medical leadership, staff, and residents to optimize care level, documentation, coding, and compliance.

Provide education, peer reviews, and periodic reporting to executive committees. The role emphasizes leadership decision making, coaching talent, and building a strong UM program with cross-functional teams across UR, Case